Troubled Youth: Asthma Management

Junge Frau mit AsthmasprayAccording to the CDC, adolescent asthma is the leading chronic condition for youth so you are likely to be managing this condition if you care for juvenile offenders. Indeed, this condition is more prevalent in males and higher among black Americans, both over-represented in the incarcerated population. Concern for exacerbations and co-occurring disease management is important as young asthmatics are likely to underappreciate or even deny their condition leading to lower adherence to medication and even partaking in risky behaviors such as smoking.

Carpe Diem – Seize the Day!

As with many health conditions, incarceration is an opportune time to inform and educate your patients. Your young patients can gain a better understanding of their condition and how to manage it while in your care. Help your patients develop coping mechanism and plans to overcome barriers to self-management.

Early treatment, when the patient is young, can actually help prevent progression to irreversible lung disease with age. So, your efforts to motivate young asthmatics to manage their disease has both present and long-term benefit.

Here are some key teaching areas

  • Reporting symptoms so they can be managed before acute distress
  • What triggers their asthma and how to reduce contact with triggers
  • How to properly use inhalers, spacers, and holding chambers
  • What are rescue actions and how to take them while in detention

Individual education during clinic visits are helpful but group activities have been found to be especially beneficial for teens.

Psychological Impact

Youth is a time of significant personal and psychological development and asthma is associated with anxiety and depression in affected youth. Asthmatic youth may experience ridicule and bullying if perceived as weak or sickly.

In addition, those with severe asthma, having a history of life-threatening events, may show signs of post-traumatic stress disorder. Other developmental conditions that may be present include attention deficit disorders and learning disabilities. Consider all these possibilities when evaluating asthmatic youth and liberally recommend mental health consults and social service support, when necessary.

Practice Guidelines

The National Commission on Correctional Health Care (NCCHC) published guidelines for adolescent asthma identification and treatment that can help you set up an effective youth asthma management program. NCCHC guidelines are based on the National Asthma Education and Prevention Program Expert Panel Recommendations and include recommendations for intake history, a guide to determine disease severity, and helpful quality improvement benchmarks.

Do you provide healthcare to troubled youth? Share your experiences in the comments section of this post.

To read more about the unique aspects of juvenile health care in the correctional setting see Chapter 11 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 and shipping is free.

Photo Credit: © Kitty – Fotolia.com

Troubled Youth: Psychosocial Development Behind Bars

Serious Teenage  Boy wearing headphonesA prison sentence is challenging for the physical development of adolescents; but it can be downright devastating for psychosocial development. Psychosocial development is in full-swing during middle (15-17 years old) and late (18-21 years old) adolescence, when youthful offenders are likely a part of our patient population. This is a time when detention and association with the prison social system can have far-reaching effects. A longitudinal study published a few years back found that youth, once admitted into the juvenile justice system, were 37 times more likely to be arrested as an adult than similar kids who were not put into the system. Psychosocial development during the vulnerable adolescent years provides some insight into why this might happen.

Erikson’s Stages of Psychosocial Development is a widely accepted model of progressive psychosocial human development. Using this model, we can see how the criminal justice system might negatively affect detained youth in middle and late adolescents

Industry vs. Inferiority

Pride in accomplishment, developed from childhood through puberty, can have good results for individual identify development and self-esteem. This process can go awry, however, when youth are mixing in a criminal culture where deceit, manipulation, and bullying are often rewarded; while honesty, transparency, and kindness are socially unacceptable. In interactions with youthful offenders (really with all patients!) correctional nurses can role model and encourage positive identity development to help counteract this negative influence.

Identity vs. Role Confusion

Your adolescent patients are exploring adulthood and looking for an identity that aligns with their gifts and ambitions. This is a period of discovering who they are and their place in the world. How easy it is to take on a criminal identity when surrounded by adults or peers who, by word and action, are advocating for it. Uninformed custody professionals and even healthcare staff can encourage this identity selection through labeling and assumption. Regularly check your attitude toward your patient. Consider how your words and actions encourage or discourage a criminal role identity in interactions with your youthful patients.

Intimacy vs. Isolation

Young adults are exploring relationships that lead to long-term commitments. Youth confined for long periods with felons can end up in destructive relationships. The need for intimacy and belonging can lead to gang involvement as this insider suggests in an editorial about youth in adult prisons. Are there ways to encourage youth in your patient population toward healthier relationships? Possibly. Consider resources available in your facility. There may be outside groups such as dog training opportunities, educational sessions, or opportunity to engage in youth-specific programs.

What Can I Do?

Unfortunately, correctional nurses do not have the authority to change the juvenile justice system, although we have an obligation to work toward social justice and a better society. It would be easy to merely acknowledge this troubling information and focus on our various medical tasks – isn’t that enough? Isn’t that all we can do in this situation? Maybe so, but consider how a brief conversation or action can make a difference. We have moments in our care provision to talk with our patients. A passing word or expression of concern may have an impact – one that you may not ever see to fruition – but one that may change a life.

Consider these 5 C’s of Positive Youth Development and take opportunity to encourage in one of these areas with every patient contact:

  • Competence
  • Confidence
  • Connection
  • Character
  • Caring/Compassion

Do you provide healthcare to troubled youth? Share your experiences in the comments section of this post.

To read more about the unique aspects of juvenile health care in the correctional setting see Chapter 11 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 and shipping is free.

Photo Credit: © soupstock – Fotolia.com

Troubled Youth: Physical Development Challenges Behind Bars

GnocchiA 16 year old female is escorted to the medical clinic in a large urban jail where she is being held for arraignment for a carjacking incident. The housing officer is concerned that she has been vomiting after meals and is now refusing to eat. She appears young for her age and is underweight for her 5’6” frame. What concerns do you have if this adolescent is under your care?

No matter the age, jail is not the healthiest of places to spend time, but the growth and development needs of adolescents far outstrip the resources in many correctional settings. Correctional nurses need to be especially focused on youth in their facilities to be sure they get the attention they need. What physical development concerns should be of high priority for your youthful patient population?

Power Food – Power Struggle

A typical correctional diet is not meant to meet health spa standards but cost constraints can make some menus downright unpalatable. Turns out our 16-year-old was not tolerating the balanced but bland higher-starch diet provided. In addition, the emotional distress of incarceration can trigger appetite loss for some. Dietary intake can be one of the few life processes still in a teen’s control when behind bars. Refusing to eat or voluntarily vomiting food can be a response to a controlled environment.

Adolescents, however, need increased nutrition during growth years. Rapid development requires higher levels of protein and calcium along with zinc and iron. Some institutions provide additional milk to youthful offenders to accommodate protein and calcium needs. Food high in iron and zinc include red meats and fortified breakfast cereals. Are they available in your institution?

Young women, like the patient above, are more prone to iron deficiency. They are also prone to body-image issues that can affect nutrition. Our patient needs evaluated for an eating disorder considering her underweight appearance and post-meal vomiting.

Exercising Control

Even in the best of situations youth are not getting enough exercise, especially females. Prison can further reduce activity through limited time out of cell. Youth, particularly those confined in adult facilities or jails, may be wary of contact with other inmates. Encouraging and supporting exercise activities can improve adolescent health while reducing stress.

Sleeping Beauty

Besides good nutrition and increased activity, adolescents need quality sleep for growth and development. Sleep while incarcerated can be disrupted by security schedules, stress, fear, and uncomfortable surroundings. Help your youthful patients establish a sleep pattern that works in their housing unit. Provide sleep hygiene information and tailor it to your particular facility and housing unit routines. Find more sleep information over at CorrectionalNurse.Net.

As a resource, here is a handy Adolescent Development Table provided by the PREA Resource Center.

Do you provide healthcare to troubled youth? Share your experiences in the comments section of this post.

To read more about the unique aspects of juvenile health care in the correctional setting see Chapter 11 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 and shipping is free.

Photo Credit: © Antonio Gravante – Fotolia.com

Troubled Youth: Adolescents Behind Bars

dj wave 22Recently I consulted with a county jail that had moved adolescent detainees to a Special Needs Unit. A small facility, they had been housing adolescents among the general adult population and made the change to align with protective standards embedded in the PREA guidelines. It was a wise move on their part and got me thinking about adolescent healthcare. Correctional nurses in juvenile detention facilities, but also in many adult jails and prisons, must understand the unique health needs of their younger patients.

Do You Have Kids to Care for?

If you work in a correctional setting, chances are great that you have patients under 19 years of age. Like the county jail mentioned above, many jails throughout the country house adolescents onsite. In addition, most states have adult sentencing for some form of juvenile crime. Table 16 of the US Department of Justice Prisoners in 2011 Report (Page 83) provides a breakdown of the number of youth sentenced as adults and incarcerated in various state prison systems. Although the Federal Bureau of Prisons does not house adolescents in adult facilities, 149 federally-sentenced youth were being housed in contracted facilities in 2011. While the criminal justice system struggles with the advisability of incarcerating youth, correctional nurses must establish a program of care that attends to their health and well-being while behind bars.

Youth Troubles

Just like the adult inmate population, incarcerated youth are individuals but have some common concerns that should be at top-of-mind when delivering care. Here is a quick-start list of demographic information on youthful offenders taken primarily from the Department of Justice Survey of Youth in Residential Placement (SYRP, 2010):

  • Highly diverse ethnic background: 35% White; 32% African-American; 24% Hispanic
  • Majority 16-17 year-olds (51%)
  • High levels of substance use
  • More than half are below their expected grade in school
  • Higher rates of risky behaviors such as unprotected sex and sharing needles or piercing equipment
  • More than half take medication on a regular basis with 49% taking medication for a mental health or emotional reason
  • Significantly less healthy than the general adolescent population with higher rates of dental conditions and traumatic injury.

This information paints a picture of a patient population in need of nursing intervention. Incarceration is an opportune time to increase knowledge and motivation for healthy adult living. It is also a time to deal with unattended health issues and link youth to community health services.

Do you provide healthcare to troubled youth? Share your experiences in the comments section of this post.

To read more about the unique aspects of juvenile health care in the correctional setting see Chapter 11 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 and shipping is free.

Photo Credit: © Durluby – Fotolia.com